原发性胆囊癌的外科治疗和预后影响因素分析

Analysis of surgical treatment and factors influencing prognosis for gallbladder carcinoma

目的探讨原发性胆囊癌外科治疗和预后影响因素以提高胆囊癌患者生存率。方法回顾性分析我院肝胆外科1994年1月至2014年7月接受外科治疗的174例胆囊癌患者临床资料,分析各因素对预后的影响。结果 142例患者获随访,胆囊癌临床表现缺乏特异性,术前诊断以影像学为相对主要手段,诊断符合率腹部超声为54.3%,CT为66.7%,MRI为69%;治疗以根治性切除为主,患者中位生存时间为18.5个月,1,2,3,5年总体生存率分别为72%,31%,14%,6%。单因素和多因素分析显示,Nevin分期、手术方式及淋巴结转移为患者术后生存的独立因素(P<0.05)。结论密切注意高危人群临床表现,结合影像学检查早期诊断胆囊癌,行R0根治性或扩大根治手术治疗是胆囊癌首选治疗方式,彻底清扫各组淋巴结,是提高胆囊癌患者生存率的关键。

Objective To investigate surgical treatments and factors influencing prognosis in primary gall-bladder carcinoma, to improve survival rate. Methods The clinical data of 174 patients with gallbladder carcinoma surgically treated in our hospital between 1994 and 2014, were retrospectively analyzed and studied by univariate and multivariate analysis. Results A total of 142 patients were followed-up. The clinical manifestations of gallbladder carcinoma were lack of specificity. The relatively exact diagnosis was based on radiology, the exact diagnostic rate of abdominal ultrasound was 54.3%, CT was 66.7% and MRI was 69%. Radical resection was the main treatment for gallbladder carcinoma. The median survival time of all the patients was 18.5 months, the overall 1-, 2-, 3- and 5-year survival rate were 72%, 31%, 14% and 6%, respectively. Both univariate analysis and multivariate analysis showed that Nevin stage, surgical procedure mode and lymphatic metastasis were independent factors influencing the survival （P〈0.05）. Conclusion It is important to notice the clinical symptoms of the high risk patients and make an earlier diagnosis by means of imaging examinations. The radical or even extended operation is firstly to be chosen, including lymph nodes completely dissection, which was the key measure to improve the survival rate.